| Objective: To explore the treatment of common clinical hypertensive cerebral hemorrhage(HICH)by drilling and external drainage after body surface projection guided by 3D-Slicer.Make more elaborate preoperative preparation plan for common hypertensive cerebral hemorrhage.Method: Patients diagnosed as primary cerebral hemorrhage in the Second Affiliated Hospital of Yan ’an University and the First Hospital of Yulin City from September 2020 to December 2022 were collected A total of 103 patients(30ml≤hematoma volume <50ml,40 years ≤ age <70 years,8 points ≤GCS score <12 points)who underwent trepanation and catheter external drainage were divided into three groups according to whether 3D-Slice three-dimensional reconstruction was performed before surgery.The 3D-Slice puncture group received 3D-Slice three-dimensional reconstruction of brain CT and assisted positioning puncture30 cases were treated with conventional puncture,30 cases were treated with conventional puncture and 43 cases were treated with conservative therapy.All patients were followed up for 6 months.Preoperative preparation time and operation time were compared between the two groups.Postoperative puncture satisfaction rate(the distance between the puncture target point of drainage tube and the center of hematoma after operation,and the distance within 3mm is considered satisfactory);The time of extubation after operation in two groups;24 hours after operation,the clearance rate of hematoma was reexamined by CT,and the time needed for hematoma absorption to be over 90% in conservative treatment group and two operation groups;The volume of brain edema in three groups was treated for 2 weeks;The incidence of complications in the three groups,the degree of fiber bundle injury after DTI of brain function before and two weeks after operation in 12 cases of 3d-slicer puncture group and 12 cases of traditional puncture group respectively;Activity of daily living scale(ADL)and stroke scale(NIHSS)were used to evaluate the changes of neurological function and the recovery of ADL before and 1 month after treatment,and GOS score was used to evaluate the prognosis of patients 6 months after treatment.The time and cost of hospitalization in conservative treatment group,3d-slicer paracentesis group and traditional paracentesis group.The results of the three groups were compared and statistically analyzed.The application of 3D-Slicer software,clinical value and points for attention were introduced.Results: The results are not the same when different treatment methods are selected.For the patients selected for surgical treatment,the preoperative preparation time of3D-Slice puncture group was longer than that of traditional puncture group(P<0.05);However,the operation time was shorter,with statistical difference(P<0.05).The postoperative puncture satisfaction rate of 3D-Slice puncture group was(86.7%),the postoperative hematoma clearance rate was(79.14±3.01)%,and the postoperative extubation time was(2.41±0.28)days,which was better than that of traditional puncture group,with statistical difference(P<0.05).In addition,patients who underwent 3D-Slice puncture had faster postoperative hematoma absorption,smaller brain edema volume and fewer postoperative complications than patients who underwent traditional puncture and conservative treatment.In the evaluation of postoperative nerve recovery indicators,the FA values obtained by DTI in 3D-Slice puncture group and traditional puncture group were significantly different at 2 weeks after operation,and the difference was statistically significant(P<0.05).FA value reflects the close situation of fiber bundles.We can conclude that the integrity of the fiber bundle in the 3D-Slice puncture group was better than that in the conventional puncture group before and 2 weeks after surgery.Three groups of patients with different treatment after 1 month were assessed with NIHSS score and ADL score,the difference between the three was significant,statistically significant(P<0.05);The NIHSS score of 3D-Slice puncture group was significantly lower than that of traditional puncture group and conservative treatment group,and the ADL score of 3D-Slice puncture group was significantly lower than that of conservative treatment group and traditional puncture group(P<0.05).Compared with the conservative treatment group,the NIHSS score of the patients in the traditional puncture group was lower 1 month after treatment,but the ADL score was higher than that in the conservative treatment group,with significant difference(P<0.05).The NIHSS scores of the three groups were all lower than those before treatment,and the ADL scores of the three groups were all higher than those before treatment,with significant difference(P<0.05).There was significant difference in prognosis among the three groups at 6months after operation(P<0.05).The prognosis of 3D group was better than that of conservative group(P<0.05),but there was no significant difference between 3D group and traditional group(P=0.051).The prognosis of patients in the traditional group was better than that in the conservative treatment group,and the difference was statistically significant(P<0.05).However,the length of hospital stay and cost of patients in the3d-slicer group were superior.Conclusion: According to 3D-Slice,the three-dimensional reconstruction of the brain CT data of patients with cerebral hemorrhage was performed,and then the hematoma was projected on the body surface.Compared with the traditional drainage method and conservative treatment,the external drainage with drilling and catheterization could accelerate the removal and absorption of hematoma,reduce the complications of patients,promote early exercise and rehabilitation,and reduce the hospitalization time and cost.In terms of the treatment level of primary hospitals,this method is more beneficial to patients and suitable for promotion in primary hospitals. |
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